Provider Demographics
NPI:1659545481
Name:MARTIN E EISNER MD INC
Entity Type:Organization
Organization Name:MARTIN E EISNER MD INC
Other - Org Name:MARTIN E EISNER MD FACS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:ELI
Authorized Official - Last Name:EISNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-564-8200
Mailing Address - Street 1:PO BOX 62316
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-6077
Mailing Address - Country:US
Mailing Address - Phone:714-731-7871
Mailing Address - Fax:714-731-7872
Practice Address - Street 1:999 N TUSTIN AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-6504
Practice Address - Country:US
Practice Address - Phone:714-564-8200
Practice Address - Fax:714-953-3425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43023208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA49199Medicare UPIN
CAGY3023Medicare Oscar/Certification